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Proteeae groin skin carriage among nursing home residents--resistance to antiseptics
D G Eckert1, N J Ehrenkranz, B C Alfonso
1Florida Consortium for Infection Control, Miami 33143.
Abstract:
Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.
Insights
Antiseptic treatments, including isopropyl alcohol and chlorhexidine, failed to eliminate Proteeae bacteria from groin skin. Repeated cleansing and antibiotic interventions were also ineffective in clearing these persistent skin colonizers.
Area of Science:
- Microbiology
- Dermatology
- Infectious Diseases
Background:
- Proteeae species, including Proteus mirabilis, are known colonizers of human skin.
- Groin skin carriage of bacteria can be influenced by various factors, including hygiene practices and antimicrobial exposure.
Purpose of the Study:
- To evaluate the efficacy of antiseptic interventions in eradicating Proteeae carriage from groin skin.
- To investigate the persistence of Proteeae and associated aerobic gram-negative bacilli (AGNB) following antimicrobial treatments.
Main Methods:
- Carriage of Proteeae was assessed in individuals.
- Antiseptic treatments with isopropyl alcohol and chlorhexidine were applied.
- A series of body baths with soap, chlorhexidine, and povidone-iodine, along with cefazolin injections, were administered over a period.
- Reculturing was performed at various time points to assess bacterial load and clearance.
Main Results:
- Isopropyl alcohol and chlorhexidine did not reduce Proteeae numbers on groin skin up to eight hours post-application.
- Multiple antiseptic body baths and cefazolin injections failed to clear Proteeae carriage in most subjects.
- All subjects became carriers again within three months.
- Proteeae carriers frequently harbored other aerobic gram-negative bacilli (AGNB), including antibiotic-resistant strains.
Conclusions:
- Vigorous antiseptic application is ineffective in clearing Proteeae from groin skin.
- Proteeae groin skin carriage may indicate a significant alteration in the resident skin microbiota.
- Persistent carriage suggests a need for alternative strategies to manage Proteeae colonization.